RR 2 - Box 103 - Ainsworth, NE 69210
402-387-2311 - Fax 402-387-2313

Vergil Heyer DVM                    Kip Lukasiewicz DVN                    Chris Finney DVM

SHIPPED SEMEN REQUEST
Owner Name Ship To (if different)
Address Address
   
Phone Phone
Mare Name                                                                                                           AQHA #
Stallion Name
Date Shipment Requested

All requests must be made by 8:00AM and shipment occurs by 10:00AM via Fed Ex or UPS Next Day Air, please specify preference.

NO Saturday shipments.

Include credit card information for ALL contracts not paid in full or for RESHIPMENTS.
Credit Card #                                     -                                    -                                    -
Type of Card                                                                                                            Expiration Date
Verification # (3 digit code on back of card)
FAX TO 402-387-2312